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Fungal Infections

Comments from Expert Advisory Committee

  • Clinically candida infections can present as four main variants: pseudomembranous, erythematous, denture stomatitis and hyperplastic. Chronic hyperplastic candidiasis may have malignant potential and therefore refer patients with this condition for specialist treatment.
  • N.B. oral candidiasis may be a clinical marker for an underlying pre-disposing condition e.g. diabetes, nutritional deficiencies, immuno-compromise, or may be associated with the use of inhaled/systemic corticosteroids, cytotoxics, or broad-spectrum antimicrobials.
  • Fungal infections in immuno-compromised patients may need intravenous systemic treatment and should be referred if they fail to respond to first line therapy.
  • If an infant being breast-fed is identified as having an oral candida infection, treatment of the mother also needs to be considered with referral to GP. Further information can be found under nipple/breast thrush management
  • Note that Nystatin suspension contains 0.5g of sucrose per ml. This should be taken into account in patients with diabetes mellitus or glucose intolerance and the dental effects of sucrose should be considered with prolonged or repeated use.
  • Note that miconazole gel and fluconazole can interact with many drugs such as warfarin and statins – check for drug interactions before prescribing.

Local Measures

  • Advise patients using corticosteroid inhalers to rinse their mouth with water or brush teeth immediately after use.
  • Advise denture wearers re denture hygiene – leave the denture out at night time and leave it soaking in Steradent® solution, chlorhexidine mouthwash or sodium hypochlorite overnight  (Note: hypochlorite can only be used for dentures with no metal parts).
  • Leave the dentures out as often as possible during the treatment period.
  • Assess adequacy of denture.

Treatment

Where anti-fungal treatment is considered necessary:

fungal infections feb 2021


Patient Information

Visit HPSC Information Leaflets pages for the General Public, (MRSA, CRE, etc)

Safe Prescribing (visit the safe prescribing page)

  • Doses are oral and for adults unless otherwise stated
  • Drug interactions table. Extensive drug interactions for clarithromycin, fluoroquinolones, azole antifungals and rifampicin. Many antibiotics increase the risk of bleeding with anticoagulants.
  • Visit the Health Products Regulatory Authority (HPRA) website for detailed drug information (summary of product characteristics and patient information leaflets). Dosing details, contraindications and drug interactions can also be found in the Irish Medicines Formulary (IMF) or other reference sources such as British National Formulary (BNF) / BNF for children (BNFC).

Reviewed February 2021

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